Provider Demographics
NPI:1366009169
Name:WILLIAMS, JOHN POWELL IV (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:POWELL
Last Name:WILLIAMS
Suffix:IV
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 19TH ST STE 503
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1874
Mailing Address - Country:US
Mailing Address - Phone:865-331-1111
Mailing Address - Fax:
Practice Address - Street 1:501 19TH ST STE 503
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1874
Practice Address - Country:US
Practice Address - Phone:653-331-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ053289Medicaid
1162330OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS